Characteristics of Successful Neurosurgical Practices

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The characteristics below are adapted from an article published in the Journal of the Nebraska Bar Association. The article described successful law practices but the parallels with successful neurosurgical practices seemed obvious and analogous.

Successful neurosurgical practices have:

1. Focused surgeons – a collection of practices that have no interaction with one another and merely exist under one roof tend to be less successful and lead to internal competition, work hoarding, jealousy and suspicion. Successful practices have a focus and each surgeon should develop specialized expertise consistent with that focus.

2. Commitment to Quality – both technical quality and service quality (i.e. low morbidity and mortality as well as high patient satisfaction)

3. Collegiality and Esprit de Corps – successful practices have a team attitude and spirit including a willingness to share work and patients. Practices with this attribute are comprised of surgeons who care about and respect the persons for whom and with whom they work, trust their employees to be smart and use initiative, and genuinely seek input regarding changes or challenges. The surgeons in a successful practice must be willing to help each other out in the many small ways that are the essence of a neurosurgical practice – they must assist, support, encourage, and cooperate with each other. This does not mean that everyone is the best of friends. However, unless a practice is more than a compensation arrangement, it is doomed to have many problems and defections.

4. Loyalty – Fragmented practices are plagued by surgeons who have little allegiance and commitment to the practice and fail to keep confidences and build relationships. Loyalty is strengthened when individuals are respected and involved in making decisions that affect them. It thrives when credit and decision making are shared, when a job well-done is recognized, and where relationships are honest, fair and consistent. It evaporates when secrecy, poor communication, and caste systems exist among partners or staff.

5. Leadership – effective leadership involves spending time to articulate practice goals and objectives and motivating partners and employees to embrace those goals and objectives. It requires a positive example, consensus building, fairness, patience and good communication. Most importantly, leaders subordinate their own interests to those of the practice.

6. Accountability – successful practices demand that members take responsibility for their positive and negative acts. A lack of accountability breeds apathy, sloth and frustration.

7. Shared financial rewards – in sound practices, the most productive surgeons do not always receive all the financial rewards they have earned; the concept of a partnership necessitates sharing with others. This attribute is frequently weak or missing in practices with an eat-what-you-kill compensation system or one that primarily rewards individual performance and profitability.

8. Sense of fairness – successful practices realize that not all decisions can be made objectively. Many decisions are based on subjective factors that can cause disagreement. It is important, however, that everyone feels that he or she is being treated fairly most of the time.

9. Willingness to place the interests of the practice first – selfishness and unwillingness to compromise weaken and ultimately destroy a practice. Often individuals must subordinate personal interests and aspirations for the good of the whole. Consensus legitimizes important decisions the practice makes but not all decisions need unanimous consent or agreement since requiring it would paralyze a practice.

10. Understanding where the practice is going – there must be common goals and aspirations that neurosurgeons and staff understand. In addition there must be a sense of vision. If you don’t know where you’re going, you might end up somewhere else.

11. Progressive attitude and spirit – maintaining the status quo often stymies creativity, new opportunities, and new challenges. Successful practices use a practice approach to resolve problems and react to opportunities. Less successful practices have a reactive approach to resolving problems and disputes or an if-it-ain’t-broke-don’t-fix-it attitude. In a competitive marketplace, practices with an entrepreneurial spirit and a willingness to take reasonable risks will thrive and prosper.

12. Patient driven decision making – the well-known maxim “the patient always comes first” applies to neurosurgical practices. All decisions and efforts must be focused on what is in the best long-term interests of patients. Patient communications, service, and needs are paramount concerns in the best practices.

13. Diversity – a successful practice has respect for diversity in ideas, gender, age, ethnic background, religion, and education.

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